Ballard Jeanne L, Auer Christine E, Khoury Jane C
Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0541, USA.
Pediatrics. 2002 Nov;110(5):e63. doi: 10.1542/peds.110.5.e63.
Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls.
We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time.
Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 +/- 2.31 down to 1.2 +/- 1.52.
Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.
母乳喂养婴儿的舌系带过短可导致含接无效、乳汁传输不足及母亲乳头疼痛，从而导致过早断奶。在这种情况下，舌系带修整术对母乳喂养的母婴是否有益仍存在争议。我们希望：1）界定严重舌系带过短；2）确定母乳喂养婴儿中的发病率；3）衡量舌系带修整术对于解决以自身为对照的母婴对中特定母乳喂养问题的有效性。
我们检查了2763名住院母乳喂养婴儿和273名有母乳喂养问题的门诊婴儿是否可能存在舌系带过短，并使用Hazelbaker舌系带功能评估工具对每名患有舌系带过短的婴儿进行评估。然后在母乳喂养时观察每对母婴。当发现含接问题时，我们让母亲描述在乳房上吸吮的感觉和质量。当描述有疼痛时，我们让母亲用1至10分对疼痛程度进行评分。当舌功能受损时，我们与家长讨论舌系带修整术并获得知情同意。手术后，让婴儿回到母亲身边进行母乳喂养。此时重新评估婴儿的含接情况和母亲的乳头疼痛情况。
88名（3.2%）住院婴儿和35名（12.8%）门诊婴儿被诊断为舌系带过短。对于含接不良和乳头疼痛的主要症状，平均Hazelbaker评分相似。出现含接不良时婴儿的中位年龄（第25和第75百分位数）低于乳头疼痛时：分别为1.2天（0.7，2.0）和2.0天（1.0，12.0）。所有舌系带修整术均顺利完成。所有病例的含接情况均有改善，术后母亲的疼痛程度显著下降：从6.9±2.31降至1.2±1.52。
舌系带过短在新生儿群体中是一个相对常见的发现，并且在母乳喂养问题中占相当大的比例。婴儿含接不良和母亲乳头疼痛经常与此发现相关。仔细评估舌功能，必要时进行舌系带修整术，似乎是在存在严重舌系带过短时促进母乳喂养的一种成功方法。
